Long-term survival of patients with unresectable colorectal cancer liver metastases following infusional chemotherapy with 5-fluorouracil, leucovorin, oxaliplatin and surgery

Giacchetti, Sylvie; Itzhaki, M.; Gruia, G.; Adam, René; Zidani, R.; Kunstlinger, F; Brienza, S.; Alafaci, Elisabetta; Bertheault-Cvitkovic, F.; Jasmin, C; Reynès, M; Bismuth, H.; Misset, Jean-Louis; Lévi, Françis

doi:10.1023/a:1008347829017

Cited by 565 publications

(246 citation statements)

References 34 publications

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“…Neoadjuvant chemotherapy prior to surgery can downstage previously unresectable hepatic metastases in up to 38% of patients and ease the resection in those already resectable [11][12][13]. Despite improved selection of patients, outcome remains the same with an overall 5-year survival similar in patients with clinically resectable metastatic disease with and without neoadjuvant chemotherapy prior to resection (52% vs. 38% respectively, P ¼ 0.35) [14].…”

Section: Discussionmentioning

confidence: 99%

Response to chemotherapy predicts survival following resection of hepatic colo‐rectal metastases in patients treated with neoadjuvant therapy

Small¹,

Lubezky²,

Shmueli³

et al. 2008

Journal of Surgical Oncology

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Background: Prognosis of patients following resection of CRC metastases to the liver has traditionally been predicted by clinical risk factors. In the era of neoadjuvant chemotherapy, determination of new prognostic indicators of outcome are necessary. Methods: This retrospective study includes patients with CRC liver metastases, who received oxaliplatin or irinotecan based neoadjuvant chemotherapy and underwent R0 resection. Patients were followed by CT and PET-CT, before, during and after chemotherapy and surgery. The predictive value of the Memorial Sloan-Kettering Cancer Center Clinical Score (MSKCC-CS) and degree of response to chemotherapy (measured by CT and PET-CT), were analyzed by univariate and multivariate COX regression. Results: Included are 54 patients. Overall 1-, 2-, 3-year survival rates 88%, 70%, and 39%. Response to chemotherapy on CT was a significant predictor of survival on univariate (P ¼ 0.03) and multivariate analysis (P ¼ 0.03), whereas MSKCC-CS and response to chemotherapy on PET-CT were not. Multivariate analysis demonstrated response to chemotherapy as a predictor of time to recurrence on CT (P ¼ 0.02) and PET-CT (P ¼ 0.03), while the MSKCC-CS (P ¼ 0.64) was not. Conclusions: In this cohort of patients treated by neoadjuvant chemotherapy, the outcome was not predicted by the traditional clinical scoring system, but rather by response to chemotherapy as evaluated by CT and PET-CT.

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Section: Discussionmentioning

confidence: 99%

Response to chemotherapy predicts survival following resection of hepatic colo‐rectal metastases in patients treated with neoadjuvant therapy

Small¹,

Lubezky²,

Shmueli³

et al. 2008

Journal of Surgical Oncology

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“…Giacchetti et al (1999) reported that 77 out of 151 (51%) patients had surgery with curative intent following neoadjuvant treatment with 5-FU/FA/oxaliplatin. Complete resection was achieved in 58 patients.…”

Section: Discussionmentioning

confidence: 99%

Final analysis of colorectal cancer patients treated with irinotecan and 5-fluorouracil plus folinic acid neoadjuvant chemotherapy for unresectable liver metastases

et al. 2007

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We have previously reported that neoadjuvant therapy with modified FOLFIRI enabled nearly a third of patients with metastatic colorectal cancer (mCRC) to undergo surgical resection of liver metastases. Here, we present data from the long-term follow-up of these patients. Forty patients received modified FOLFIRI: irinotecan 180 mg m À2 , day 1; folinic acid, 200 mg m À2 ; and 5-fluorouracil: as a 400 mg m À2 bolus, days 1 and 2, and a 48-h continuous infusion 1200 mg m À2 , from day 1. Treatment was repeated every 2 weeks, with response assessed every six cycles. Resected patients received six further cycles of chemotherapy postoperatively. Nineteen (47.5%) of 40 patients achieved an objective response; 13 (33%) underwent resection. After a median follow-up of 56 months, median survival for all patients was 31.5 months: for non-resected patients, median survival was 24 months and was not reached for resected patients. Median time to progression was 14.3 and 5.2 months for all and non-resected patients, respectively. Median disease-free (DF) survival in resected patients was 52.5 months. At 2 years, all patients were alive (8 DF), and at last follow-up, eight were alive (6 DF). Surgical resection of liver metastases after neoadjuvant treatment with modified FOLFIRI in CRC patients achieved favourable survival times.

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“…In the remainder, the hepatic lesion is either ill sited, too large or multinodular, and therefore deemed to be unresectable. In a proof-of-principle retrospective study, evaluating a chronomodulated schedule of 5-FU/FA and oxaliplatin, Giacchetti et al (1999) demonstrated that first-line cytotoxic chemotherapy had downsized a significant fraction of unresectable disease to operability. Specifically, following the treatment of 151 patients with liver-only, previously inoperable metastatic disease, 77 were subsequently resected with curative intent.…”

Section: Hepatic Resectionmentioning

confidence: 99%

Management of advanced colorectal cancer: state of the art

Saunders

Iveson

2006

Br J Cancer

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Colorectal cancer (CRC) caused over 500 000 deaths worldwide in 2002. Recent advances in the treatment of advanced disease include the incorporation of two new cytotoxic agents, irinotecan and oxaliplatin, into first-line regimens. The concept of planned sequential therapy involving three active agents during the course of a patient's treatment is evolving. Coupled with the integrated use of targeted monoclonal antibodies, we can now expect overall survival rates for advanced disease to exceed 20 months. This review considers current treatments and suggests where future progress may occur.

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Long-term survival of patients with unresectable colorectal cancer liver metastases following infusional chemotherapy with 5-fluorouracil, leucovorin, oxaliplatin and surgery

Abstract: This new strategy of combining effective chemotherapy with surgery apparently altered the natural history of unresectable colorectal cancer metastases.

Cited by 565 publications

References 34 publications

Response to chemotherapy predicts survival following resection of hepatic colo‐rectal metastases in patients treated with neoadjuvant therapy

Response to chemotherapy predicts survival following resection of hepatic colo‐rectal metastases in patients treated with neoadjuvant therapy

Final analysis of colorectal cancer patients treated with irinotecan and 5-fluorouracil plus folinic acid neoadjuvant chemotherapy for unresectable liver metastases

Management of advanced colorectal cancer: state of the art

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